Educating Providers in Return-to-Play Suggested Guidelines Postconcussion.

As the awareness of concussions increases, it is imperative to be able to evaluate, diagnose, and treat concussed individuals properly to prevent further complications or death. The primary purpose of this study was to compare a provider's current awareness and comfort level as it relates to the return-to-play guidelines for concussions. A secondary aim was to evaluate current protocols that are in use and determine whether they coincide with the suggested guidelines. An educational intervention was implemented to assess the knowledge and confidence of health care providers. The study design was a quantitative, convenient sample, pretest/posttest questionnaire. The questionnaire was administered to participants who were nurse practitioners prior to an educational PowerPoint presentation. At 8 weeks, the posttest was administered. Approximately 19% of individuals were not aware of a graded return-to-play protocols. The findings suggest that the educational intervention increased their confidence levels in making a diagnosis of a concussion, in assessing danger signs, and in understanding when to refer to a specialist. Additional supporting evidence from this study indicates that the educational intervention allowed the participants to achieve a greater comfort level in finding appropriate resources for them and their patients.

Endogenous fecal losses of calcium compromise calcium balance in pancreatic-insufficient girls with cystic fibrosis.

OBJECTIVE: Bone mineral density is compromised in individuals with cystic fibrosis (CF); calcium is the major bone mineral. This study examined the impact of endogenous fecal calcium (V(endo)) losses on calcium balance in girls with CF. Study design V(endo) was measured in 12 girls with CF (aged 7-18 years): 7 younger, premenarcheal girls with compromised nutritional status; and 5 older, postmenarcheal girls with adequate nutritional status. V(endo) was measured as the amount of intravenously administered (42)Ca, a calcium stable isotope, in stool relative to urine over 6 days. V(endo) was compared between pre- and postmenarcheal girls by Student's t test. Actual calcium balance [absorbed calcium-(urinary calcium (V(u))+V(endo))] was compared with estimated balance (assuming V(endo)=1.6 mg/kg/day calcium) by paired t test. RESULTS: V(endo) was 99.3+/-42.3 mg/day. By body weight, V(endo) was highest among premenarcheal girls (3.37+/-1.09 mg/kg/day), resulting in excess losses (>1.6 mg/kg/day) of 55.0+/-45.7 mg/day. Over 1 year, this represents 20.1+/-16.7 g of unattained bone calcium or 6.7+/-4.2% of the bone calcium content of these girls. CONCLUSIONS: V(endo) is a significant source of calcium loss in individuals with CF and may limit calcium availability for bone mineral deposition.